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GIHEP Surgery - Pancreatitis + Pancreatic Carcinoma (ii) Acute…
GIHEP Surgery - Pancreatitis + Pancreatic Carcinoma (ii) Acute pancreatitis cntd
Management
IV fluids
analgesia
patient monitoring
hrly urine
clinical situation can change rapidly
assess severity
manage systemic + local complications
antibiotics in pancreatic necrosis (meropenem)
initially NPO (nil per os) + introduce feeding when possible
antithrombotic prophylaxis (risk of DVT)
Complications
pseudocyst formation
@ 6 wks - if formed before this then it is called a pancreatic collection
pseudo - no epithelial lining
can cause patient to represent after discharge
adjacent to pancreas + anything in abdo cavity
tx: drain into stomach (stomach is well-vascularised so heals after incision)
pancreatic abscess
necrotising pancreatitis
@ 7-10 days
if you suspect it repeat CT - you will see pancreatic tissue that doesn't enhance/with air inside
2 phases
@ 1-2 wks: severe SIRS due to cks
@ 2+ wks: sepsis-related complications due to infected pancreatic necrosis
management
percut needle aspiration to see if it's sterile or not
pancreatic necosectomy (surgery) if a/w fever
if sterile non-op management (draining - may take months)
infected pancreatic necrosis account for 80% of mortality a/w acute pancreatitis
intra-abdo sepsis
necrosis of transverse colon (uncommon)
ARDS
inability to oxygenate
patchy infiltrates
put patient on ventilator
pleural effusions
risk of infection + empyema if not drained, which may then require lung resection
ATN (Acute Tubular Necrosis)
death of tubular epithelial cells that form the renal tubules of the kidneys
pancreatic haemorrhage
due to blood vessels being digested
often self-limiting
hard to tx
chronic pancreatitis
mortality
metabolic - hyperglycaemia, hypocalcaemia
SI ileus
air buildup - can obstruct view of pancreas on US hence do CT
vomiting, anorexia, maybe consider other forms of nutrition
renal failure - often early complication, may require dialysis
CV compromise - tachycardia, hypotension (maybe give NA), HF
SIRS - global
Prevention of further episodes
recurrence possible, with each event causing more scarring
cholecystectomy
gallstones - 30% risk of 2nd episode (average @ 3 months)
EUS/MRCP/ERCP
risk of gallstones falling out during operation without surgeon noticing
alcohol withdrawal
psychological
pharmacological
alcohol damages + narrows ducts - predisposition
tx hypercalcaemia + hyperlipidaemia
look for pancreatic neoplasms - 10% present with acute pancreatitis